Maternity, newborn care required coverage under ACA

Robyn Lehmen, left, and Gayle Vice prepare an infant for her trip home. Both are registered nurses in St. Mary’s Health Center Blessed Beginnings OB ward. The baby's parents took the 3-day-old home to join her older brother.
Photo by Julie Smith.

Editor’s note: This is the fourth in a series of stories that will explain the 10 essential health benefits required under the Affordable Care Act and explore what effect those requirements will have on patients and caregivers.

Under the Affordable Care Act (ACA), health insurance plans are now required to cover maternity and newborn care — one of 10 essential health benefits required by the law.

Tracy O’Rourke with St. Mary’s Health Center (SMHC) said access to prenatal care is critical for the health of the mom and the baby.

“We want to ensure there’s coverage for that, that it’s convenient and that it’s affordable,” said O’Rourke, vice president of strategy and marketing at SMHC. “Insurance often is a component of having access to services and quality health care.”

She said the Jefferson City community has access to a community health center and the hospital has other sources for moms not covered by health insurance.

“But again, Medicaid expansion and other things that we know are on the table are always for us to ensure that there’s coverage,” she said.

She said since the ACA went into effect in 2010, insurance providers have been required to provide access to women’s services, which she said includes prenatal care and education, and supplies for breast-feeding.

“Beginning this year, what we understand is that most health plans will also include maternity and newborn care within those services,” O’Rourke said. “We had looked at some stats in terms of what that would be and I think around 8-9 million Americans will be able to have access then to maternity coverage through that new provision.

“Those are things that we’ve been keeping an eye on.”

In 2013, more than 1,500 babies were born at Jefferson City hospitals — 926 babies at Capital Region Medical Center and 625 babies at SMHC.

O’Rourke said that with more insured mothers, health care entities like SMHC will be able to continue building better health for patients.

“We will continue to look at education ahead of delivery and while they’re here,” she said, “whether it’s their birth plan or how they want to care for the baby.”

Your questions

The News Tribune received one question this week about the ACA:

Q: If I sign up for health insurance by March, do I have to pay a fine for not having it Jan. 1, 2014?

A: According to healthcare.gov, if you enroll in a health insurance plan through the Marketplace by March 31, 2014, you won’t have to pay a penalty for any of the previous months of 2014.

Do you have questions?

We want to answer your questions regarding the ACA; email reporter Olivia Ingle at olivia@newstribune.com or call her at 573-761-0248.

Also, feel free to share your experiences with the ACA or your experiences signing up for coverage in the Marketplace.